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Orthopedic Coding Alert

You Be the Coder:

Is Pre-Op EPO Reimbursable?

Published on Sun Jun 01, 2003

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: We often administer epoetin alfa injections prior to total hip and knee replacement surgery to prevent anemia, but Medicare keeps denying our claims (we report Q0136). What are we doing wrong? Minnesota Subscriber

Answer: Most insurers will deny claims for epoetin alfa injections (Q0136, Injection, epoetin alpha, [for non-ESRD use], per 1,000 units) unless the patient actually has some form of anemia (280.0-285.9). Most Medicare carriers maintain LMRPs for epoetin alfa injections, spelling out the conditions under which it will be covered. Epoetin alfa is not covered when it is administered to increase the amount of blood that can be drawn for auto-donation prior to surgery or to prime a patient prior to surgery.

If the patient wants you to administer the injection anyway, ask him or her to sign an advance beneficiary notice (ABN) so you can bill him or her directly when Medicare denies the claim.  

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